<html>
<wicket:panel>
	<style type="text/css">
.valid {
	background-color: green;
}

.invalid {
	background-color: red;
}
</style>
	<div>



	<form wicket:id="add_form">

	<table>
		<tr>
			<td colspan="2"><b><wicket:message key="AddUser.title" /> </b></td>

		</tr>
		<tr>
			<td><wicket:message key="AddUser.name" /></td>
			<td>:</td>
			<td><input type="text" wicket:id="account.accountName" /></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.password" /></td>
			<td>:</td>
			<td><input type="password" wicket:id="account.password" /></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.repeat_password" /></td>
			<td>:</td>
			<td><input type="password" /></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.account_type" /></td>
			<td>:</td>
			<td><select wicket:id="Role">
				<option>role1</option>
				<option>role2</option>
				<option>role3</option>

			</select></td>
		</tr>
		<tr>
			<td colspan="2"><b><wicket:message
				key="AddUser.personal_data" /> </b></td>

		</tr>
		<tr>
			<td><wicket:message key="AddUser.personal_name" /></td>
			<td>:</td>
			<td><input type="text" wicket:id="name" /></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.tele" /></td>
			<td>:</td>
			<td><input type="text" wicket:id="tele" /></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.mobil" /></td>
			<td>:</td>
			<td><input type="text" wicket:id="mobil" /></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.email" /></td>
			<td>:</td>
			<td><input type="text" wicket:id="email" /></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.address" /></td>
			<td>:</td>
			<td><textarea rows="2" cols="50" wicket:id="address">&#160</textarea>
			</td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.birth_date" /></td>
			<td>:</td>
			<td><input type="text" wicket:id="brithDate" /></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.gender" /></td>
			<td>:</td>
			<td><input type="checkbox" wicket:id="gender" /></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.martity_status" /></td>
			<td>:</td>
			<td><select wicket:id="marity">
				<option>expend</option>
				<option>nice</option>
				<option>good</option>

			</select></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.smoker" /></td>
			<td>:</td>
			<td><input type="checkbox" wicket:id="smoker" /></td>
		</tr>
		<tr>
			<td><wicket:message key="AddUser.insurance" /></td>
			<td>:</td>
			<td><select wicket:id="insurance">
				<option>expend</option>
				<option>nice</option>
				<option>good</option>

			</select></td>
		</tr>
		<tr>
			<td><wicket:message key="note" /></td>
			<td>:</td>
			<td><textarea rows="2" cols="50" wicket:id="note">&#160</textarea></td>
		</tr>
		<tr>
			<td colspan="3" align="center"><span wicket:id="feedback"
				align="left"></span><input type="submit" value="add"
				wicket:id="Add" /> <input type="reset" value="add & continue"
				wicket:id="addAndContinue" /> <input type="reset" value="close"
				wicket:id="close" /></td>

		</tr>
	</table>
	</form>
	</div>
</wicket:panel>

</html>

